The association between social support, intrusive thoughts, avoidance, and adjustment following an experimental cancer treatment

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Abstract
A social-cognitive processing model was used to examine the association of social support with intrusive thoughts and avoidance in predicting adjustment in 53 patients receiving an experimental vaccine for the treatment of either metastatic melanoma (n=24) or metastatic renal cell cancer (n=29). Social support, intrusive thoughts/avoidance, psychological distress and quality of life were assessed on the day of the first treatment, on the day of the final treatment, and 1 month after the end of treatment during a routine follow-up visit. Social support at the beginning of treatment was negatively associated with psychological distress and positively associated with mental health quality of life (QOL) 1 month after treatment, and these associations were mediated by intrusive thoughts/avoidance at the end of treatment. There was also an interaction between social support and intrusive thoughts/avoidance at the beginning of treatment in predicting both psychological distress and mental health QOL 1 month after treatment. Specifically, for patients with lower levels of support, greater intrusive thoughts/avoidance was associated with greater psychological distress and poorer mental health QOL 1 month after treatment. However, there was no association between intrusive thoughts/avoidance and adjustment in patients with high levels of social support. These results suggest that social support buffers the negative association between intrusive thoughts/avoidance and psychological adjustment. Overall, the results are consistent with a social-cognitive processing model of post-trauma reactions among cancer patients. Our results highlight the need to assess patients' perceived support and to further develop and assess the benefits of interventions to increase patients' supportive networks and to facilitate cognitive processing of the cancer experience. Copyright © 2003 John Wiley & Sons, Ltd.